[Differentiated thyroid carcinoma, 1972-1992. Follow-up, detection of recurrences and prognostic factors].
BACKGROUND
There is no consensus about the treatment and the follow-up of differentiated thyroid carcinoma (DTC), because in some patients, currently known prognostic factors cannot predict the course of the disease. The aim of this work has been to review the results of the treatment of our patients with DTC and to assess the prognostic factors.


METHODS
We include, retrospectively, 204 patients with DTC (54 males and 150 women) with a men (SD) age of 38 (23) years, attending to a terciary university hospital. The follow-up is 9.2 (6) years (range, 2-22 years). They all underwent near total thyroidectomy, ablative doses of radioactive iodine (131INa) and L-thyroxine to suppress thyroid stimulating hormone (TSH) levels. At least once a year, a clinical examination, a whole-body scan (WBS) with 131INa and serum thyroglobulin (Tg) measurements were performed in hypothyroid state. In the statistics, chi 2 test, univariate analysis, Student's t test, Kaplan-Meier method, Mantel-Cox test and multiple regression analysis were employed.


RESULTS
The survival rate was 89.05%. Twenty patients died of DTC (9.8%) (papillary 8 [6%], follicular 12[17%]). Surgical complications (recurrent nerve palsy or permanent hypoparathyroidism) were seen in 5% of the patients. The sensitivity of WBS to detect distant metastases or local (neck) involvement was 71% (initial 100%, late 71%). Tg sensitivity was 85% (initial 95%, late 73%). Factors associated to a poor prognosis were age > 40 years (p < 0.0001), follicular carcinoma (p < 0.02) and initial stages III and IV (p < 0.0001).


CONCLUSIONS
The mortality and complications rates in our patients with differentiated thyroid carcinoma validate our management schedule. Tg measurements are more sensitive than WBS to detect distant or local metastases; however, sensitivity of both techniques was lower in the detection of late metastases. Age below 40 years, papillary carcinoma and initial stages I and II are factors of better prognosis.
Obiols
G
G
Sección de Endocrinología, Hospital General i Universitari Vall d'Hebron, Barcelona.
Simó
R
R
Burgos
R
R
Tresserras
R
R
Galofré
P
P
Masmiquel
L
L
Hernández
C
C
Mesa
J
J
D018263:Adenocarcinoma, Follicular / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012044:Regression Analysis; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D013965:Thyroidectomy; D013974:Thyroxine / Q000627:therapeutic use
D007457:Iodine Radioisotopes; D013974:Thyroxine
Carcinoma diferenciado de tiroides, 1972-1992. Estudio evolutivo, detección de recurrencias y factores pronósticos.